They may end up seeing a range of specialists, as the symptoms cut across medical specialities, leading to a lack of ownership of these patients, especially when they attend the ED. “People come into hospital with breathlessness and it could understandably end up being worked up by cardiac, respiratory, ENT or gastroenterology specialists, leading to a host of investigations before seeing the right team”, she says. Danielle says patients can also end up being treated with unnecessary medications. In 2024, she was awarded a Northern Sydney Local Health District (NSLHD) Innovation grant to help develop a more streamlined pathway to care for patients with upper airway disorders. As part of the grant, Danielle and RNSH respiratory colleagues have been reviewing records of 90 patients admitted between 2022 and 2024. From a preliminary assessment of 15 records, this group of patients had gone to the ED a total of 33 times and been admitted to the respiratory ward 16 times. Each hospital ward admission cost approximately $4,500.
The time from the initial ED visit to correct diagnosis averaged 505 days, further confirming these patients were waiting a long time to get a diagnosis. Fortunately, Danielle has found that for the majority of patients audited so far, after being treated by a speech pathologist, there were no further respiratory admissions. “We want a situation where patients are not only treated more quickly, but they are also less likely to take unnecessary medication and undergo less unnecessary testing,” says Danielle. The respiratory department team is currently developing referral criteria, an online education program for clinicians and an assessment tool which will be embedded within RNSH’s Respiratory Investigation Unit. The long-term goal is to develop a distinct service to look after people with breathing and upper airway disorders.
Gnocchi chef Melissa Canclini
Understanding upper airway and breathing disorders
Vocal cord dysfunction (or Inducible Laryngeal Obstruction) is a condition where people feel like their airway is shutting down
Chronic cough affects an estimated 10 per cent of the world’s population.
Dysfunctional breathing or breathing pattern disorder is a condition where the sufferer feels an almost constant sensation of breathlessness or air hunger.
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